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  <head>
    <title>新增毒品使用情况表</title>
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    <#include "/template/head.html">
    <script type="text/javascript" src="${basePath}js/common.js" charset="utf-8"></script>
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    $.metadata.setType("attr", "validate");
    $(document).ready(function() {
      $("#dpsybForm").validate();
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  </head>
  <body>
    <form id="dpsybForm" action="${basePath}brxx/save.do" method="post">
      <table class="cmxform">
        <caption>新&nbsp;&nbsp;增&nbsp;&nbsp;毒&nbsp;&nbsp;品&nbsp;&nbsp;使&nbsp;&nbsp;用&nbsp;&nbsp;情&nbsp;&nbsp;况&nbsp;&nbsp;表</caption>
        <tr>
          <th width="12%">KICID号：</th>
          <td width="38%"><input name="kicid" value="${baseInfo.kicid}" class="disabled" readonly/></td>
          <th width="12%">病人姓名：</th>
          <td width="38%"><input name="brxm" value="${baseInfo.brxm!}"  class="disabled" readonly/></td>
        </tr>
        <tr>
          <td colspan="4">
            <span style="color:blue">附表3填写说明：日期格式 yyyy-MM-dd；</span>
          </td>
        </tr>
        <tr>
          <th>1、您是否进过戒毒中心：</th>
          <td colspan="3">
            <span onclick="rotDis('jdzx', 'checked', [1], 'jdzxmc_warp')">
              <input type="radio" name="jdzx" value="1"/>是
              <input type="radio" name="jdzx" value="0"/>否
            </span>
            <span id="jdzxmc_warp" class="none">
              <label for="jdzxmc">戒毒中心的名称：</label>
              <input name="jdzxmc" disabled="disabled"/>
            </span>
          </td>
        </tr>
        <tr>
          <th colspan="4" class="indent2em left">
            <label>2、是否曾经尝试或使用过，说明使用毒品情况，以及是否在患病之前6个月使用过：</label>
            <span onclick="rotDis('xsdp', 'checked', [1], 'tb_xsdp_detail')">
              <input type="radio" name="xsdp" value="1"/>是
              <input type="radio" name="xsdp" value="0"/>否
            </span>
            <table id="tb_xsdp_detail" class="none inform" cellspacing="1">
              <tr>
                <th colspan="3" class="left">通过吸烟、鼻吸、口吸、加热、吞服</th>
              </tr>
              <tr>
                <th width="20%">1、大麻：<input type="checkbox" name="xsdm" value="1" disabled="disabled" onclick="rotDis('xsdm', 'checked', [1], 'xsdm_warp')"/>是</th>
                <td colspan="2">
                  <span id="xsdm_warp" class="none">
                    <label> 频次 </label>
                    <input name="xsdmpc2" disabled="disabled" class="w60"/>/
                    <select name="xsdmpc1" disabled="disabled">
                      <option></option>
                      <#list constants.fqcOfDp as item>
                      <option value="${item_index+1}">${item}</option>
                      </#list>
                    </select>（次）
                    <label> 使用了多长时间 </label>
                    <input name="xsdmsj" disabled="disabled"/>
                  </span>
                </td>
              </tr>
              <tr>
                <th>2、可卡因：<input type="checkbox" name="xskky" value="1" disabled="disabled" onclick="rotDis('xskky', 'checked', [1], 'xskky_warp')"/>是</th>
                <td colspan="2">
                  <span id="xskky_warp" class="none">
                    <label> 频次 </label>
                    <input name="xskkypc2" disabled="disabled" class="w60"/>/
                    <select name="xskkypc1" disabled="disabled">
                      <option></option>
                      <#list constants.fqcOfDp as item>
                      <option value="${item_index+1}">${item}</option>
                      </#list>
                    </select>（次）
                    <label> 使用了多长时间 </label>
                    <input name="xskkysj" disabled="disabled"/>
                  </span>
                </td>
              </tr>
              <tr>
                <th>3、安非他明：<input type="checkbox" name="xsaftm" value="1" disabled="disabled" onclick="rotDis('xsaftm', 'checked', [1], 'xsaftm_warp')"/>是</th>
                <td colspan="2">
                  <span id="xsaftm_warp" class="none">
                    <label> 频次 </label>
                    <input name="xsaftmpc2" disabled="disabled" class="w60"/>/
                    <select name="xsaftmpc1" disabled="disabled">
                      <option></option>
                      <#list constants.fqcOfDp as item>
                      <option value="${item_index+1}">${item}</option>
                      </#list>
                    </select>（次）
                    <label> 使用了多长时间 </label>
                    <input name="xsaftmsj" disabled="disabled"/>
                  </span>
                </td>
              </tr>
              <tr>
                <th>4、丁基硝酸钠：<input type="checkbox" name="xsxsn" value="1" disabled="disabled" onclick="rotDis('xsxsn', 'checked', [1], 'xsxsn_warp')"/>是</th>
                <td colspan="2">
                  <span id="xsxsn_warp" class="none">
                    <label> 频次 </label>
                    <input name="xsxsnpc2" disabled="disabled" class="w60"/>/
                    <select name="xsxsnpc1" disabled="disabled">
                      <option></option>
                      <#list constants.fqcOfDp as item>
                      <option value="${item_index+1}">${item}</option>
                      </#list>
                    </select>（次）
                    <label> 使用了多长时间 </label>
                    <input name="xsxsnsj" disabled="disabled"/>
                  </span>
                </td>
              </tr>
              <tr>
                <th>5、五氯酚（迷幻药）：<input type="checkbox" name="xsmhy" value="1" disabled="disabled" onclick="rotDis('xsmhy', 'checked', [1], 'xsmhy_warp')"/>是</th>
                <td colspan="2">
                  <span id="xsmhy_warp" class="none">
                    <label> 频次 </label>
                    <input name="xsmhypc2" disabled="disabled" class="w60"/>/
                    <select name="xsmhypc1" disabled="disabled">
                      <option></option>
                      <#list constants.fqcOfDp as item>
                      <option value="${item_index+1}">${item}</option>
                      </#list>
                    </select>（次）
                    <label> 使用了多长时间 </label>
                    <input name="xsmhysj" disabled="disabled"/>
                  </span>
                </td>
              </tr>
              <tr>
                <th>6、摇头丸：<input type="checkbox" name="xsytw" value="1" disabled="disabled" onclick="rotDis('xsytw', 'checked', [1], 'xsytw_warp')"/>是</th>
                <td colspan="2">
                  <span id="xsytw_warp" class="none">
                    <label> 频次 </label>
                    <input name="xsytwpc2" disabled="disabled" class="w60"/>/
                    <select name="xsytwpc1" disabled="disabled">
                      <option></option>
                      <#list constants.fqcOfDp as item>
                      <option value="${item_index+1}">${item}</option>
                      </#list>
                    </select>（次）
                    <label> 使用了多长时间 </label>
                    <input name="xsytwsj" disabled="disabled"/>
                  </span>
                </td>
              </tr>
              <tr>
                <th>7、吸入剂（有其、杀虫剂、胶水）：<input type="checkbox" name="xsxrj" value="1" disabled="disabled" onclick="rotDis('xsxrj', 'checked', [1], 'xsxrj_warp')"/>是</th>
                <td colspan="2">
                  <span id="xsxrj_warp" class="none">
                    <label> 频次 </label>
                    <input name="xsxrjpc2" disabled="disabled" class="w60"/>/
                    <select name="xsxrjpc1" disabled="disabled">
                      <option></option>
                      <#list constants.fqcOfDp as item>
                      <option value="${item_index+1}">${item}</option>
                      </#list>
                    </select>（次）
                    <label> 使用了多长时间 </label>
                    <input name="xsxrjsj" disabled="disabled"/>
                  </span>
                </td>
              </tr>
              <tr>
                <th>8、其他（海洛因）：<input type="checkbox" name="xsqt" value="1" disabled="disabled" onclick="rotDis('xsqt', 'checked', [1], 'xsqt_warp')"/>是</th>
                <td colspan="2">
                  <span id="xsqt_warp" class="none">
                    <label> 频次 </label>
                    <input name="xsqtpc2" disabled="disabled" class="w60"/>/
                    <select name="xsqtpc1" disabled="disabled">
                      <option></option>
                      <#list constants.fqcOfDp as item>
                      <option value="${item_index+1}">${item}</option>
                      </#list>
                    </select>（次）
                    <label> 使用了多长时间 </label>
                    <input name="xsqtsj" disabled="disabled"/>
                  </span>
                </td>
              </tr>
            </table>
          </th>
        </tr>
        <tr>
          <th colspan="4" class="indent2em left">
            <label>3、是否曾经把毒品注射进您的静脉、动脉、肌肉、皮肤、或身体其他部位：</label>
            <span onclick="rotDis('zsdp', 'checked', [1], 'tb_zsdp_detail')">
              <input type="radio" name="zsdp" value="1"/>是
              <input type="radio" name="zsdp" value="0"/>否
            </span>
            <table id="tb_zsdp_detail" class="none inform" cellspacing="1">
              <tr>
                <th colspan="3" class="left">注射毒品</th>
              </tr>
              <tr>
                <th width="20%">1、可卡因：<input type="checkbox" name="zskky" value="1" disabled="disabled" onclick="rotDis('zskky', 'checked', [1], 'zskky_warp')"/>是</th>
                <td colspan="2">
                  <span id="zskky_warp" class="none">
                    <label> 频次 </label>
                    <input name="zskkypc2" disabled="disabled" class="w60"/>/
                    <select name="zskkypc1" disabled="disabled">
                      <option></option>
                      <#list constants.fqcOfDp as item>
                      <option value="${item_index+1}">${item}</option>
                      </#list>
                    </select>（次）
                    <label> 使用了多长时间 </label>
                    <input name="zskkysj" disabled="disabled"/>
                  </span>
                </td>
              </tr>
              <tr>
                <th>2、海洛因、吗啡、氢吗啡酮：<input type="checkbox" name="zshly" value="1" disabled="disabled" onclick="rotDis('zshly', 'checked', [1], 'zshly_warp')"/>是</th>
                <td colspan="2">
                  <span id="zshly_warp" class="none">
                    <label> 频次 </label>
                    <input name="zshlypc2" disabled="disabled" class="w60"/>/
                    <select name="zshlypc1" disabled="disabled">
                      <option></option>
                      <#list constants.fqcOfDp as item>
                      <option value="${item_index+1}">${item}</option>
                      </#list>
                    </select>（次）
                    <label> 使用了多长时间 </label>
                    <input name="zshlysj" disabled="disabled"/>
                  </span>
                </td>
              </tr>
              <tr>
                <th>3、Speedball（可卡因与海洛因合剂）：<input type="checkbox" name="zsSpeedball" value="1" disabled="disabled" onclick="rotDis('zsSpeedball', 'checked', [1], 'zsSpeedball_warp')"/>是</th>
                <td colspan="2">
                  <span id="zsSpeedball_warp" class="none">
                    <label> 频次 </label>
                    <input name="zsSpeedballpc2" disabled="disabled" class="w60"/>/
                    <select name="zsSpeedballpc1" disabled="disabled">
                      <option></option>
                      <#list constants.fqcOfDp as item>
                      <option value="${item_index+1}">${item}</option>
                      </#list>
                    </select>（次）
                    <label> 使用了多长时间 </label>
                    <input name="zsSpeedballsj" disabled="disabled"/>
                  </span>
                </td>
              </tr>
              <tr>
                <th><label for="zsafgm">4、安非他明：</label><input type="checkbox" name="zsafgm" value="1" disabled="disabled" onclick="rotDis('zsafgm', 'checked', [1], 'zsafgm_warp')"/>是</th>
                <td colspan="2">
                  <span id="zsafgm_warp" class="none">
                    <label> 频次 </label>
                    <input name="zsafgmpc2" disabled="disabled" class="w60"/>/
                    <select name="zsafgmpc1" disabled="disabled">
                      <option></option>
                      <#list constants.fqcOfDp as item>
                      <option value="${item_index+1}">${item}</option>
                      </#list>
                    </select>（次）
                    <label> 使用了多长时间 </label>
                    <input name="zsafgmsj" disabled="disabled"/>
                  </span>
                </td>
              </tr>
              <tr>
                <th>5、其他：<input type="checkbox" name="zsqt" value="1" disabled="disabled" onclick="rotDis('zsqt', 'checked', [1], 'zsqt_warp')"/>是</th>
                <td colspan="2">
                  <span id="zsqt_warp" class="none">
                    <label> 频次 </label>
                    <input name="zsqtpc2" disabled="disabled" class="w60"/>/
                    <select name="zsqtpc1" disabled="disabled">
                      <option></option>
                      <#list constants.fqcOfDp as item>
                      <option value="${item_index+1}">${item}</option>
                      </#list>
                    </select>（次）
                    <label> 使用了多长时间 </label>
                    <input name="zsqtsj" disabled="disabled"/>
                  </span>
                </td>
              </tr>
            </table>
          </th>
        </tr>
        <tr>
          <th colspan="4" class="indent2em left">4、你是否曾同时使用过2种或2种以上的毒品：
            <input type="radio" name="twodp" value="1"/>是
            <input type="radio" name="twodp" value="0"/>否
          </th>
        </tr>
        <tr>
          <th colspan="4" class="indent2em left">
            <label>5、你是否曾使用过别人使用过的注射器，或与别人共用注射器：</label>
            <span onclick="rotDis('gyzsq', 'checked', [1], 'tb_gyzsq_detail')">
              <input type="radio" name="gyzsq" value="1"/>是
              <input type="radio" name="gyzsq" value="0"/>否
            </span>
            <table id="tb_gyzsq_detail" class="none inform" cellspacing="1">
              <tr>
                <th width="25%">使用别人使用过的注射器的频次：</th>
                <td>
                  <select name="gyzsqpc" disabled="disabled"> 
                    <option></option>
                    <#list constants.fqcOfDp2 as item>
                    <option value="${item_index+1}">${item}</option>
                    </#list>
                  </select>
                </td>
              </tr>
              <tr>
                <th width="25%">你使用别人使用过的注射器有多长时间：</th>
                <td>
                  <input name="gyzsqsj" disabled="disabled" class="w60"/> 月
                </td>
              </tr>
              <tr>
                <th width="25%">你总共使用过多少人的注射器：</th>
                <td>
                  <input name="gyzsqrc" disabled="disabled" class="w60"/> 人
                </td>
              </tr>
            </table>
          </th>
        </tr>
        <tr>
          <th colspan="4" class="indent2em left">
            <label>6、你是否曾使用过漂白剂清洗你的注射器或其他用具：</label>
            <span onclick="rotDis('pbj', 'checked', [1], 'tb_pbj_detail')">
              <input type="radio" name="pbj" value="1"/>是
              <input type="radio" name="pbj" value="0"/>否
            </span>
            <table id="tb_pbj_detail" class="none inform" cellspacing="1">
              <tr>
                <th width="25%">使用漂白剂的频次：</th>
                <td>
                  <select name="pbjpc" disabled="disabled"> 
                    <option></option>
                    <#list constants.fqcOfDp2 as item>
                    <option value="${item_index+1}">${item}</option>
                    </#list>
                  </select>
                </td>
              </tr>
              <tr>
                <th width="25%">你使用漂白剂有多长时间：</th>
                <td>
                  <input name="pbjsj" disabled="disabled" class="w60"/> 月
                </td>
              </tr>
            </table>
          </th>
        </tr>
        <tr>
          <th colspan="4" class="indent2em left">
            <label>7、你是否曾与他人共用注射毒品处理器具：</label>
            <input type="radio" name="gyzsqj" value="1"/>是
            <input type="radio" name="gyzsqj" value="0"/>否
          </th>
        </tr>
        <tfoot>
          <tr>
            <td colspan="4">
              <input type="hidden" name="curStep" value="dpsyb"/>
              <input type="hidden" name="chain" value="${chain}"/>
              <input type="hidden" id="action" name="action" value="forward"/>
              <button type="button" class="back" onclick="$('#action').val('reverse');$('#dpsybForm').submit()"></button>&nbsp;&nbsp;&nbsp;
              <button type="button" class="next" onclick="$('#dpsybForm').submit()"></button>
            </td>
          </tr>
        </tfoot>
      </table>
    </form>
  </body>
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